APPENDIX-XI

FORM ‘S’
(Vide rule 21)

Application for Registration of birth of a child of a Citizen of Pakistan born in a country

outside Pakistan

To:
…………………………………………….
…………………………………………….

Sir,

The undersigned reports the birth of male/female child to Mr. and Mrs.………….………………….
(In block letters) on …………………………… day of ……………………19 ………… at…………………
District ……………………………… Country ………………………………………………………………

The child has been name ……………………………………………………………. (block letters)

I am the father/guardian of the child and my full name and address is as follows:

Name with father’s named……..…………………………………………………..….(block letters)

Address in country outside Pakistan …………………………………………………………………
Address in Pakistan ………………………………………………………………………………….

I/The child’s father was/was not at the time of the child’s birth a servant of a Government in
Pakistan …………………………… or of an international organization of which Pakistan was at any time
during that period a member. The full names and address of the child’s parents are given below:

Father’s name and address in Name with father’s name ……………………………………

Pakistan and in the country (in block letters)
Outside Pakistan Address in Pakistan …………………………………………..
Address in the country outside Pakistan ……………………..
………………………………………………………………..

Mother’s name and address in Name with father’s name …………………………………….

Pakistan and in the country (in block letters)
Outside Pakistan Address in Pakistan ………………………………………….
Address in the country outside Pakistan …………………….
……………………………………………………………….

I am attaching the following documents in proof of my citizenship of Pakistan and of the child’s birth as
reported above:
(a) ……………………………………………………………………………………………..
(b) ………………………………………………………………………………………………
(c) ………………………………………………………………………………………………
 I am a national of ………………………………… (Give name of the country) also and I give the
following particulars of the nationality certificate and passport issued by that country:-

(a) Number and date of issue of nationality certificate.

(b) Number, date and place of issue of passport.

I do solemnly affirm that the above statement is true to the best of my knowledge and belief.

Signature …………………………
Place ……………………………..
Date ………………………………

Attestation ……………………………………….
Designation ……………………………………...
Place and Date …………………………………..

1
. Inserted vide S.R.O. 155/ (I)/73 dated 01-02-1973